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. 2022 Feb 13;11(4):977.
doi: 10.3390/jcm11040977.

Temporal Change in Renoprotective Effect of Tolvaptan on Patients with Heart Failure: AURORA Study

Masami Nishino  1 , Yasuyuki Egami  1 , Akihiro Tanaka  1 , Shodai Kawanami  1 , Hiroki Sugae  1 , Kohei Ukita  1 , Akito Kawamura  1 , Hitoshi Nakamura  1 , Yutaka Matsuhiro  1 , Koji Yasumoto  1 , Masaki Tsuda  1 , Naotaka Okamoto  1 , Yasuharu Matsunaga-Lee  1 , Masamichi Yano  1 , Jun Tanouchi  1
Affiliations

Temporal Change in Renoprotective Effect of Tolvaptan on Patients with Heart Failure: AURORA Study

Masami Nishino et al. J Clin Med. .

Abstract

(1) Background: It has been reported that tolvaptan (TLV) has a renoprotective effect in acute decompensated heart failure (ADHF) patients, but whether this effect is continued for a long time is unclear. Thus, we evaluated the time course of the renoprotective effect of TLV, in addition to the prognosis, in ADHF patients. (2) Methods: We investigated 911 ADHF patients from the AURORA (Acute Heart Failure Registry in Osaka Rosai Hospital) registry. After propensity score matching, 58 patients who started to receive TLV at least two days after the hospitalization (TLV group) and 58 who did not (non-TLV group) were examined. We compared the changes in the creatinine (Cr) and estimated glomerular filtration rate (eGFR) between baseline and each time point (five days, discharge, and one year) as the index of the renoprotective effect, and rate of rehospitalizations and all-cause mortality for one year between the two groups. (3) Results: The change in Cr and eGFR levels was significantly higher in the TLV group than the non-TLV group five days after admission but the difference between the two groups gradually diminished. A Kaplan-Meier analysis showed that the survival and rehospitalization rates in the TLV and non-TLV groups were similar up to one year. (4) TLV revealed a temporal change in the renoprotective effect, which may be correlated with no long-term beneficial effect of TLV.

Keywords: diuretics; heart failure; renal function; tolvaptan.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient study flow chart. AURORA, Acute Heart Failure Registry in Osaka Rosai Hospital; RH, rehospitalization; TLV, tolvaptan.
Figure 2
Figure 2
(A): Changes in the serum creatinine (Cr) between baseline and each time point (five days post-admission, discharge, and one-year) in the TLV and non-TLV groups. (B): Changes in the estimated glomerular filtration rate (eGFR) between baseline and each time point in the TLV and non-TLV groups. The abbreviations are the same as in Figure 1. * p < 0.05 for TLV group vs. non-TLV group.
Figure 2
Figure 2
(A): Changes in the serum creatinine (Cr) between baseline and each time point (five days post-admission, discharge, and one-year) in the TLV and non-TLV groups. (B): Changes in the estimated glomerular filtration rate (eGFR) between baseline and each time point in the TLV and non-TLV groups. The abbreviations are the same as in Figure 1. * p < 0.05 for TLV group vs. non-TLV group.
Figure 3
Figure 3
Incidence of worsening renal failure between the TLV and non-TLV group. WRF, worsening renal failure.
Figure 4
Figure 4
(A): Kaplan–Meier curve for the survival ratio between the TLV and non-TLV group in a propensity score-matched population. (B): Kaplan–Meier curve for the rehospitalization free ratio between the TLV and non-TLV group in a propensity score-matched population. The abbreviations are the same as in Figure 1.
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